Selling an organ in Singapore is strictly against the law and protocols, under the Human Organ Transplant Act (Hota) and Oaths and Declarations Act. So how did two Indonesians almost get away with selling their kidneys to recipients in Singapore. In fact, one of the transactions were complete, before any charges were laid.
This is the first time that the current laws banning organ trade have been invoked since they were introduced twenty years ago.
The Ministry of Health (MOH) are still investigating the transactions, with assistance from several Singaporeans.
The first Indonesian charged, 26-year old Sulaiman Damanik, pleaded guilty in a district court and was convicted on Friday. Sulaiman was apprehended before he could have the surgery to remove his kidney. He had previously arranged with an executive chairman, 54-year old Tang Wee Sung, to sell him the organ for around $22,000 (150 million rupiah).
Under the current protocols in Singapore, organ donation is not entirely illegal, and the guidelines allow for close relatives of the recipient to donate. In the case of unrelated donors, the MOH makes a determination on a 'case by case' basis, depending on things such as medical emergency and the donor's motives (which cannot under any circumstances, be motivated by money or profit).
So on June 17th, Sulaiman was brought before a private hospital's ethics commitee, at which time he purported to be a close relative of Mr Tang - he claimed that Mr Tang's niece was married to his aunt. He further claimed that by making the donation, he would achive no financial gain or payment for the kidney. These claims have later proven to be false.
The second Indonesian convicted is known as Toni and is 27-years of age. He had already given his kidney to Ms Juliana Soh in March this year, for a payment of 186 million rupiah which he received upon his return to his home in Medan. He then acted as the 'go between' for Sulaiman and Mr Tang's transaction. He returned to Singapore to assist the former on May 29th.
Toni and Sulaiman are likely to be sentenced for their respective crimes on Wednesday of this coming week.
MORE ARRESTS PENDING?
As the investigations have been unfolding, MOH have met the ethics panel of a particular unnamed private hospital, and some lawyers have been contacted by some of the people who have been assisting with police investigations, looking for legal counsel to act on their behalf. This seems to be a very strong indication that more people are likely to be charged under Hota.
ISSUE WITH CURRENT GUIDELINES AND PROTOCOLS
The biggest problem for authorities in detecting breaches of the laws, is the fact that it is often difficult to prove a relationship between the donor and the recipient. Both parties must make statutory declarations and present their cases to the ethics committees, but there is no 'exhaustive' way of proving the parties are related.
CROSS-BORDER BLACK MARKET
The cross-border blackmarket demand is seemingly quite large, with Dr Pary Sivaraman (consultant kidney and transplant physician at the Singapore Clinic for Kidney Diseases) stating that he gets at least two emails a week from foreign organ buyers looking for a donor, while also receiving emails from potential organ sellers (usually from Indonesia or India) advising their health condition, age, and placing a price on their 'offered kidney' - anywhere between US$10,000 to US$30,000.
Reports today in the media, have cited that more than 600 Singaporeans have sought out donors overseas throughout the last 20 years. Most of these potential recipients have tried to eke out opportunities in China or India, where it is easiest to buy the organs.
On average, kidney patients wait approximately nine years for a transplant, dependent upon whether or not a suitable kidney can be found.
The petient at the heart of the recent controversy, Mr Tang was interviewed in 2006, and had said that he needed a transplant soon, and rather than approaching family members, was considering taking his search for an organ abroad and having the operation performed in Beijing, where he had friends who are doctors.
LEGAL TRANSPLANTS - IMPORTANT INFORMATION!!
The Human Organ Transplant Act (Hota) was enacted in 1987 because there was a growing number of patients with renal failure but a lack of donors. The act, which allows organs to be removed when a person dies, was initially limited to the kidneys as there were no heart or liver transplant programs then.
Doctors may now also remove the liver, heart and cornea of ALL Singaporeans and Permanent Residents upon their deaths, following the amendment to the act in January, 2004. Organs may be removed from anyone who is brain-dead, unless the person has opted out os is a muslim who has not opted in.
A transplant ethics commitee at each hospital will decide whether to allow a transplant from a living donor. Donating organs for money and organ trading remains illegal. Offenders face a fine of up to $10,000 and/or imprisonment for up to one year.